'We know one of our beautiful girls must die'

Doctors yesterday began detailed preparations for the operation to separate conjoined baby girls who share a heart.

Tragically, they already know that Natasha and Courtney Smith cannot both survive.

Natasha will be given their heart, as most of it is already in her body, and Courtney will die.

Before the surgeons can operate, they must carry out a series of assessments and scans to build a picture of the twins' organs and complex blood system.

The girls, who have a combined weight of 9lb 12oz, (4.42kg), were born on Monday at Queen Charlotte's and Chelsea Hospital in West London.

They were transferred almost immediately to Great Ormond Street Hospital in Central London, where any separation operation will be performed.

The babies' parents, Tina May and Dennis Smith, from St Albans, Hertfordshire, have spoken movingly of their joy and their fears for the twins.

Miss May, a 23-year-old receptionist, told the Sun newspaper yesterday: 'When I saw them for the first time they looked so beautiful that I melted with love for them. But my happiness is tinged with the agony of knowing the ordeal that lies ahead.'

Bus driver Mr Smith, 33, told the paper: 'They are proving to be the little fighters we always knew they were.

'They have been kicking their arms and legs and it sounds like they are developing their own little personalities. I was rooted to the spot just staring as they kept pulling funny facial expressions.'

The couple, both Roman Catholics, have been warned that Natasha will face a battle against the odds to survive.

The babies' shared heart is deformed, and unless the abnormality can be corrected, she will die within months.

Professor Nicholas Fisk, who led the team which delivered the twins by Caesarean section, said it was a 'very traumatic and emotional' time for their parents. Referring to the likelihood of them losing at least one of the babies, he said: 'This was a possibility they have been entertaining.

'Seeing the babies for the first time was quite an emotional moment. Until yesterday they have only seen them on the ultrasound screen and there was something special about looking at them.

'There's always doubt in these cases that there could be other problems but they were in good condition. They cried and gurgled and opened their eyes.'

Dr Helena Gardiner, a perinatal cardiologist who was also at the girls' birth, said: 'It's a complicated heart, perhaps more complicated than we understand at the moment. There are some parts of the circulation we need to investigate further before surgery.'

She added: 'As far as I know there has never been a case of a baby surviving more than a few months when they were joined like this. It is exceptionally rare.'

Professor Fisk warned: 'There can be, sadly, no chance of survival for Courtney. Natasha will succumb within the first few months, a year at the latest, unless the abnormality in her heart is corrected.

'That cannot be corrected while the circulation of Courtney is hooked on to her own.'

Professor Fisk said Miss May was in 'quite good spirits' in the West London hospital and was hoping to visit her babies today.

Without being separated, both twins will die within months. Doctorsmay yet decide not to operate if they find their blood vessels are too intertwined. Earlier fears that they shared a liver, however, have proved unfounded.

A separation would spark a similar debate to the operation two years ago on Gracie and Rosie Attard. They made legal history in a hugely controversial High Court case in which judges ruled that the surgery should go ahead.

The girls' parents, devout Roman Catholics, had refused to give permission because it was certain that Rosie, who was totally dependent on Gracie's organs, would die.

The difference in the latest case is that the parents accept that an operation should be carried out.

Gracie's parents, Michael and Rina Attard, have offered support to Miss May and Mr Smith.

Speaking at their home on the Maltese island of Gozo, Mrs Attard, 35, said: 'We understand what Tina and Dennis are going through. We will write to give them our support for their courage.'

Of their own case, Mrs Attard said: 'The decision was taken out of our hands in the end. But we are happy that it was made.'

Last night the ProLife Alliance said: 'We have always suggested that a heart transplant should be considered for the weaker twin. This was the option chosen in a similar case in Italy. Heart transplants in very young babies have been undertaken in the UK.

'Even if the chance of survival is deemed minimal, it nevertheless gives the baby a glimmer of hope. Both the lives of these tiny girls are equally precious.'

An operation to separate Natasha and Courtney is unlikely to go ahead for at least a month.

It would take up to 20 hours and involve as many as nine surgeons, three or four anaesthetists and teams of paediatric nurses.

Conjoined or Siamese twins occur when a single fertilised egg splits, to form identical twins, but the separation is incomplete. They are extremely rare, around one in every 200,000 live births.